SHOULD ALL THE SILVER MERCURY FILLINGS BE REMOVED?

I would like to preface this piece by saying that I have not used silver-mercury amalgam in my practice in nearly 10 years.

Amalgam has been around for over 150 years, and it’s been controversial ever since its initial use in dentistry. Amalgam is simply a combination of metal powder (mostly silver with some copper and tin) and liquid mercury. When this combination is mixed, it forms a sort of paste that is easy to mold and shape. In a few minutes, the mixture hardens to a durable filling.

The mercury is chemically bound to the silver. However, there has always been concern about the mercury component. Mercury, as an element, is known to be toxic. But, what makes ANY material toxic to humans is the DOSE. How much does it take to be toxic to humans?

So far, there is not a single credible study that links silver amalgam fillings to any medical issue. At this point in time, scientists cannot link the presence of silver amalgam to any disease. Nor can scientists prove that removal of amalgam will prevent or cure any illness. The FDA (Food and Drug Administration) has said that amalgam fillings are safe. On the other hand, the EPA (Environmental Protection Agency) has said that silver-mercury amalgam scraps from dental offices is toxic waste and cannot be put in the trash or sewer.

So, which is it? Who do we believe?

The FDA says it’s safe to put in your mouth. But, the EPA says it’s toxic waste and shouldn’t end up in landfills or water supplies.

I haven’t used silver-mercury amalgam for nearly 10 years. But, my reasons have nothing to do with this mercury debate. I prefer composite resin for fillings, because it is a more conservative and cosmetic choice. Silver amalgam requires more removal of healthy tooth to mechanically lock the material into the cavity preparation. Composite resin BONDS to tooth structure. I always base my professional judgment on science. If I’m going to make a recommendation, I have to be able to back it up with scientific fact.

With that in mind, I do not recommend removal of silver amalgams with no defects or decay in hopes of preventing any medical issues. It’s also important to mention that any time we perform treatment on a tooth, it puts stress on that tooth. That can result in increased sensitivity, or even cause the tooth to need a root canal treatment.

However, I do acknowledge that patients have their own reasons, including cosmetic concerns. If my patients make an informed decision to have their amalgams removed, I am willing to help in any way I can.

Stan Zebrowski, D.D.S.

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